Tribute to Ernest Hilgard (2001)

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PrefaceNotes from Hypnosis in the Relief of PainPrefacePROFESSOR ERNEST HILGARD, who died on Oct 22, 2001 at the aged 97, developed hypnosis as a medical tool to help people overcome harmful habits such as smoking and also to control pain. Until he began researching the technique in the 1950s, hypnosis was regarded by most psychologists as little more than a stage trick. Many of Hilgard's academic colleagues were surprised that he should risk his reputation as a professor of psychology at Stanford University, California, by getting involved in a field otherwise monopolized, in their view, by cranks and charlatans. In partnership with his wife Josephine, a professor of clinical psychiatry at Stanford, Hilgard established the Stanford Laboratory of Hypnosis Research in 1957. To learn the basics he brought in as a collaborator a former stage hypnotist, Andre Weitzenhoffer. Together they began experimenting with hypnosis as a means of reducing the sensation of pain. In one typical experiment, a subject was told that his left hand would feel no pain when plunged into a bucket of ice-cold water. Under hypnosis, the subject confirmed that, indeed, he felt no pain. The subject was then asked to allow his right hand to engage in some "automatic writing" - that is, to let the hand write anything it wanted. "It's freezing", wrote the hand, "it hurts"; and then: "Take my hand out." Hilgard called the unhypnotized part of the mind the "hidden observer". Ostensibly, he argued, a person undergoing hypnosis to manage pain feels no conscious pain; but that does not mean the pain is not there; nor does it mean that the patient's subconscious is not registering the pain, though it is not necessarily felt as acutely as in an unhypnotized subject. In subjects particularly susceptible to hypnotic suggestion - those who could be rendered hypnotically deaf or blind, for example - Hilgard found that the "hidden observer" could recall "heard" or "seen" objects. The Hilgards went on to examine the susceptibility of potential subjects to hypnosis, concluding that the most important factor is an ability to put aside reality and absorb oneself in fantasy, as when reading a novel. By conducting experiments with groups of people showing different levels of susceptibility, they discovered that the more susceptible a person is to hypnosis, the more effective the technique as an analgesic. In 1959, they developed what became known as the Stanford Hypnotic Susceptibility Scale, a system of measurement still used by medical practitioners to determine a person's likelihood of being hypnotized and to what degree; this can indicate whether the technique would be useful as pain relief or to help cure people of habits such as smoking. In 1977 Hilgard proposed a "neodissociation" theory, which asserts that several distinct states of consciousness can be present during hypnosis, such that certain actions may become dissociated from the conscious mind. The theory remains the basis of scientific understanding of hypnosis. Ernest Ropiequit Hilgard was born at Belleville, Illinois, on July 25 1904, the son of a "horse and buggy" doctor. He showed an early interest in science, though it was engineering rather than psychology that first caught his imagination. He graduated in Chemical Engineering from the University of Illinois, writing his first scientific paper on spontaneous combustion in coal. He then changed to Psychology and took a doctorate in the subject at Yale where he met his wife, Josephine Rohrs, a fellow student. In 1933, Hilgard joined the faculty of Psychology at Stanford University in California; by 1942 he had become a professor and chairman of his department. Hilgard's initial area of academic research was conditioning and learning theory. Conditioning - the process by which a response becomes automatic as a result of reinforcement - was the subject of his early papers. He did extensive research with the human eyelid, developing a photographic technique for recording responses. This work won him the Warren Medal in Experimental Psychology in 1940. In 1946 he was a member of a mission invited to Japan by General Macarthur to advise on post-war changes in the Japanese educational system. From 1951 to 1955 he served as dean of Stanford's graduate division. In 1948, he published Theories of Learning, in which he described all the major theories in the first half of the century, analyzed their shortcomings and suggested new areas for research. The book became a classic text for psychology students and has been revised four times, most recently in 1981. By the 1950s, Hilgard had become so respected in his field that he was approached by the Ford Foundation to design a comprehensive mental health program with the American Social Science Research Council. The assignment came with a grant of $15 million, including funds for a study of hypnosis. He became a professor emeritus in 1969 but continued to serve as head of the Laboratory of Hypnosis Research. Hilgard's other publications included Conditioning and Learning (with Donald G. Marquis, 1940), and Introduction to Psychology (1953), a widely-used textbook. Together with his wife he wrote Hypnosis in the Relief of Pain (1975) and Divided Consciousness: Multiple Controls in Human Thought and Action (1977). Hilgard won many scientific awards, including the American Psychological Foundation's Gold Medal 1978 and the National Academy of Science Award for Excellence in Scientific Reviewing. He was elected to the National Academy of Sciences, the National Academy of Education, and the American Philosophical Society. He served as president of the International Society of Hypnosis and the American Psychological Association. In 1991 The American Psychologist, the group's publication, named him one of the top 10 most important contemporary psychologists. In his later years, Hilgard lectured about the history of psychology and wrote books on the subject, including American Psychology in Historical Perspective (1978) and Psychology in America: A Historical Survey (1987). In 1988 he edited Fifty Years of Psychology. Hilgard's wife died in 1989. He is survived by their son and daughter.

Notes from Hypnosis in the Relief of PainClinical pain in cancer: Pain in cancer patients may not be experienced until the cancer is an advanced state. The pain may be general in nature over large parts of the body or localized in a special area of the body. The pain is both physical and psychological. Often a cancer patient will experience the fear of death, the fear that the remaining months and years will be filled with pain, the fear of debilitation and perhaps disfiguration. These are sources of anxiety and psychological pain. Emotional reactions to cancer vary during the course of the disease. Uncertainty, depression, fear of death, despair, dread of protracted pain, changes in body image with increasing weakness, decreasing mental capacity, social isolation either self-imposed or imposed by others who withdraw because of their own anxiety. These are some of the contingencies which require a mobilization of ego functions on a scale seldom matched in the life cycle of any individual. Other realistic sources of worry are financial security of the individual and of the family, and problems rooted in the post, such as guilt, which complicate the present problem. Often the treatments for cancer can cause pain. Some treatments have unpleasant side effects, whether from an operation, from radiotherapy or chemotherapy, or from increasing dosage of analgesia. Intensive radiation or chemotherapy can produce nausea, vomiting, hair loss, and other side effects. For individuals already partially incapacitated, these constitute difficult and discouraging problems. Tranquilizers and analgesia prescribed in increasing dosages, may further dull the mind, making ego functions more fragile and social participation less rewarding. All these problems tend to intensify the physical and psychological pain.Clinical pain in obstetrics: Pain or discomfort may come in the early parts of pregnancy with nausea and vomiting. This problem is often referred to as morning sickness. These problems usually subside after a few weeks and until labor the normal pregnancy may be relative pain free. Labor is divided into three stages. First is the period during which the cervix is dilating so the baby may pass through, this is an extended period for most women. The next two periods are the passage of the baby through the birth canal - ending with the actual delivery and finally the passage of the placenta or afterbirth. The first stage of labor is variable and may take many hours, the second stage typically takes about half an hour, and the third stage a few minutes. Of course there are more difficult deliveries, such as breech deliveries, which take longer, and caesarean sections in which baby has to be removed by surgery. This is followed by the postpartum period which last about six weeks. In our society, labor is a painful experience for most women unless some form of anesthesia is employed. The contractions of labor can he painful and the delivery itself very painful.Clinical pain in surgery: For most people, an operation is associated with anxiety and tension. Numerous fears are connected with anesthesia and surgery, fear of suffocation, of not awaking, of mutilation and of what organ damage or disease may be found during surgery. In addition there is the stress of separation from familiar home and family members and substitution of a strange environment with many new procedures. It goes without saying that many patients are suffering from some degree of pain prior to surgery and the anticipation of pain after surgery. Though most surgeries are performed using some kind of anesthesia, there can be pain before and after surgery. Pain may come from a diseased body part or broken bone before surgery. Following surgery pain can be experienced in the site of the surgery and from side effects of the anesthesia, such as stomach aches and breathing problems.Clinical pain in Dentistry: Dental procedures can be quit painful and this is often intensified by fear, tension, and apprehensive. An abscessed tooth can be painful before even going to the dentist and the removal of the tooth will cause more pain. Removing teeth, filling teeth, cleaning teeth and other dental procedures are painful for many people. The fear of going to the dentist or of dental procedures are known as dental anxieties and phobias. The commonly arise from one or two sources. A previous unpleasant experience with the dentist or stories by others of a painful experience can produce a conditioned aversion. A patient's anxieties and fears may actually enhance his pain once the dental procedure begins.What are the components of pain? Pain is both a blessing and a curse. When an injury causes pain, the resulting pain is a sign that there is something to be avoided or some damage to be repaired. The information the pain conveys is useful because the site of the damage can be located and something done about it. Pain felt in the body but not associated with an injury is a warning signal that something is wrong and treatment is needed. A toothache gives information that there is a problem with the tooth. An eye ache tells us that something is wrong In the eye. These are blessings because the body's sensitives have revolved to protect us against danger. Pain is a curse when it comes to late to help the person as in some cases of cancer. Chronic pain service no useful purpose may go beyond being unpleasant; it may indeed be destructive and incapacitating. In spite of the universality of pain, it is not easy to define pain. There is a tread of distress, incompletely described by sense perception, that includes sensory pain, suffering, and mental anguish. In his book on pain, Stembach finally settled on a definition that recognized three components to pain: a component pointing to the pain sources as a harmful stimulus signaling possible damage: a pattern of responses permitting the pain to be recognized by an external observer: and finally, the subjective or private feeling of hurt. The scientific study of pain has sharpened the distinction between two components of pain, the sensory component and the suffering component. The separate experiences of pain and suffering can be characterized in two ways. One way is to assume that sensory pain is like any other perceptual response to irritation or injury: it is informative about the location and intensity of whatever may be its source. If that is the primary experience, there is a secondary experience in reaction to it-on experience of distress expressed by crying out, by movement, by facial expression, by automatic responses. This is the suffering component, a reaction that follows upon pain. A second possibility is that the two components arise simultaneously rather than successively. Sensory pain and suffering might be two ways of reacting to a common source of irritation or stress, with separate parts of the nervous system responsible for activating the two systems.Some of the research and findings concerning experimentally produced pain: (1) The research was based on two types of pain stimulation. (a) "Cold pressure pain" which depends on circulating ice water. The pain mounts very rapidly, reaching a maximum within a minute. (b) "Ischemic pain" is pain produced by the tourniquet-exercise method. Ischemic (blood-deprived) muscle, when exercised, gives rise of pain. (2) People can have pain without distress, and they can have distress without pain. (3) Two people, stimulated in the same way and experiencing the stimulus as equally painful - both as sensory pain and as distressing experience - may tolerate the pain very differently. (4) Other complexities may add to the pain experience such as fear, anxiety, and expectation. (5) "Pain sensitivity" is a common term used to describe threshold pain - the minimum amount of stimulation that can be detected as pain. (6) "Pain tolerance" is defined either by the maximum pain a person is willing to endure as the intensity of stimulation is gradually in- creased, or by the amount of time he is willing to continue accepting a pain at a given level of stimulus intensity.How is pain measured in this type of research? (1) In "cold pressure pain" experiments, the researchers asked for a report of pain every 5 seconds on a numerical scale, beginning with no pain at "0" and increasing to "10" as a critical or anchoring value, at which the subject would very much like to remove the hand from the water. This Its not the tolerance level because the subject can tolerate much more pain than this. When the subject keeps his arm in the water after reaching "10", he continues to count. It is generally found that when a hand and forearm are placed in circulating ice water, the sensation of cold quickly becomes painful; the pain mounts very rapidly, reaching a maximum within a minute. (2) When "ischemic pain" experiments are used, the subject arm is first deprived of blood by raising it and wrapping it to the elbow in an elastic bandage. Then the tourniquet a standard sphygmomanometer cuff is inflated to 250 MM, and the bandage removed. Now the subject squeezes a dynamometer at a controlled rate against a constant load of 10kg for twenty squeezes and waits; the pain mounts very slowly at first, but eventually becomes unbearable. The time required for pain to become unbearable is much longer than with ice water. (3) The researchers did not limit themselves to verbal reports of pain and suffering, but measured some physiological accomplishments of the imposed laboratory stress, primarily changes in heart rate and in systolic blood pressure. Heart rates tend to accelerate as pain increases, and blood pressure tends to rise.What is the role of hypnosis in the control of pain? Outline the historical methods used to alleviate pain to the present. a. What is the role of hypnosis in the control of pain? Hypnosis can play an important part in the control of pain, both as the sole method of reducing pain or used in connection with other pain control methods. Hypnosis can be used in the direct suggestion of pain reduction: altering the experience of pain, even though the pain may persist: and directing attention away from the pain and Its source. These approaches are not mutually exclusive and they do not include everything that: has been done.Some methods to reduce or eliminate pain by the use of hypnosis. (1) The hypnotist makes the direct suggestion that the painful area is getting numb, that it will no longer feel pain or other sensation. (2) Have the subject visualize that the nerves going to various areas of the body are controlled by switches in your brain. You can turn the switch off which goes to the painful area. Turn the switch off and the pain will subside. Hypnosis is more than a placebo for it does not mask as something it is not. (3) A Person in pain may be more easily taught first to reduce sensitivity to pain in some part of the body not now in pain. This is oftener done by making one of the hand's numb "glove anesthesia" and transferring the numbness and insensitivity from the anesthetic hand to the place where the pain is felt. This is done by having the patient rub the painful part with the already anesthetic hand while suggesting verbally that the painful. areas is becoming numb and insensitive. (4) Though hypnotic suggestion, it is sometime possible to concentrate the pain into a smaller area, and then to more it from, say, the head or back to the hands. There the pain, though still felt, may be more tolerable. In some entrances, the pain can then be converted as well. as displaced. A pain in the hand may be converted to a tingling in the fingers. (5) Hypnosis can enable a patient to forget pain that has been experienced and thereby eliminating the anticipation of pain to come. (6) Pain can be relieved by denying the existence of the painful bodily member. (7) By the use of fantasy and hallucination the person can mentally transport himself away from the present in which he is experiencing pain. These methods are concerned with the reduction of pain. Hypnosis is also helpful in reducing the emotional problems connected with pain but that area will be dealt with another time,Historical methods used to alleviate pain to the present. (1) Alcohol has been used as a pain reliever. (2) By cutting a hole in the skull, known as "trephining the skull," and letting it bleed will presumably relieves pressure and produce the cure for head pains. (3) The use of hot and cold packs using mustard or other skin irritant is known as cupping. (4) Acupuncture by inserting needles at various points and twisting is used to reduce pain. (5) Hanging something around the neck is an illustration a magical cure. (6) Faith healing is a religious cure. (6) Surgery to remove a painful or deceased body-part or to repair a broken bone is painful but used to reduce pain in the future. (7) Drugs can be used to reduce or eliminate pain In surgery or for other pains not associated with surgery. (8) placebos - harmless substance given as a pain reducer which has no pain reducing ability expert that the patient expects it to work. (9) Superficial electrical stimulation of the skin over a painful area has been widely adopted as a method of pain relief. (10) Auricutotherapy which is a form of acupuncture in which needles are placed in the external ear, with the rationale that points in the ear are homologous to portions of the human body. (11) Audioanalsesia, a machine was designed to play noise, along with music to the patient. The patient could raise the intensity of the sound to a level. at which he no longer felt pain. (12) Psychological methods are classified into three groups. (a) Treats pain as a response that can be learned and hence unlearned. (b) Those using principles of suggestion and hypnosis, (c) Those that attempt to deal with pain according to its personal significance to the person based on dynamic principles. (13) A recent addition to psychological methods is biofeedback. Learning to achieve control over what had been taught of as involuntary processes.5. Hypnosis can help improve the psychological and social situation of the cancer patient? In addition to the physical pain of cancer patients there can be significant psychological and social pain. Many people hear "death" when the hear "cancer." With this expectation comes anxiety over the fear of death, fear of pain expected as the cancer progresses, fear of debilitation, fear of disfiguration and fear of finance problems. Socially the patient fears to continue an active social life and others may fear to be socially close, to the patient. Hypnosis can help the patient relieve specific pain as well as psychological and emotional pain. (1) Encourage reassertion of ego strength to meet the crisis: (2) Relief of anxiety and pain. (3) Overcome Insomnia. (4) Broadened interest. (5) Independence gained by teaching self-hypnosis.Cite some examples of case histories to prove this. When I work with a cancer patient using hypnosis, I tell them that we are working for a better quality of life as well as the reduction of pain and healing. B was referred to me by her doctor after her second hospitalization with cancer. I met B about two years before when she had a breast removed and met her again when she had been in the hospital about a month before the doctor's referral. The cancer had spread to such a degree that surgery was not considered, so she began chemotherapy. The doctor told me that since her hospital release, B was staying at home and in bed most of the time except for trips to the doctor's office. I asked B to write down any stressful situation which she had experienced over the 6 to 18 months before her diagnosis and to list any gains she received from her illness. She listed the following: (1) A year before first cancer was discovered, her husband had left her for another woman. (2) The next month, she had to go to work to support herself and her children. (3) Filed for divorce. (4) Had her first date with another man, but worried about how her children would react. (5) Found a lump In her breast and the breast was removed. (6) Divorce final. (7) Married the man she had been dating. (8) A lump found in the other breast and a return to the hospital. (9) Doctor and patient decided not to have surgery and Chemotherapy began. For the gains of her illness, she listed (1) did not have to work. (2) Could take it easy. (3) Get more attention. (4) Can say "no" without worrying about hurting other people's feelings. We discussed how she could accomplish those gains without the excuse provided her by being sick. We talked about relaxation therapy, image therapy, hypnotherapy and self hypnosis to help her deal with a wide range of issues in her life. I asked her to do the self hypnosis with relaxation and image therapy three times a day. When B first came to me, she could see only sickness, pain, and death in her future. She used hypnosis to reduce pain by the switch methods, glove anesthesia, and viewing the pain evaporating from her painful. area as steam. She visualized herself active with her family and in the community. I told her to picture what she wanted to happen. She used self hypnosis to reduce pain, improve self esteem, and for other helpful reasons. In addition to this, she set some attainable goals which motivated her. We discussed her resentment toward her former husband and his girl friend. She came to discover that resentment keeps the hurt alive and blocks healing: emotionally, physically and spiritually. We discussed her feelings that God had forsaken her and she came to believe that God was actively helping her through her situation. We talked about set backs which she might experience. We talked about death and the grief the experienced concerning her death. About eight months later, B returned to the hospital with excess fluid in her lungs. She had just returned from a pain free vacation. She died three days later. I do not know if we added any time to B's life, but she did have a better quality of life. As a result of the therapy she lived with hopeful expectation and lived a more meaningful life. During the time before her death, B was relatively pain free and lived an active life to include enrolling in a community college. For B, hypnosis, reduced pain and fear and brought about an attitude change which helped B live a fuller life until her death.Hypnosis in the surgical setting? (1) Preoperatively hypnosis may help to overcome apprehension and anxiety about the anticipated anesthesia and surgery. In addition to reducing negative attitudes, hypnosis can frequently help to induce a calm, quiet state of mind. Sometimes hypnotic analgesia can aid in the control of pain at this stage. (2) Operatively, hypnosis may produce analgesia and anesthesia, thus reducing or replacing chemical anesthetic agents. (3) Postoperatively, hypnosis can be used for a more comfortable transition from the operative phase to convalescence. Hypnosis can help reduce pain following surgery so there is less need for postoperative narcotics. Hypnotic suggestions to reduce nausea and vomiting, to stimulate more adequate breathing and coughing, and for producing better morale. In the preoperative period, hypnosis can be used to control anxiety. This is likely to be helpful in the control of further anxiety in the operating room and during the postoperative period. During the preoperative period, a rehearsal technique in which the operation is carried out in pantomime, and everything is explained to the patient. When hypnosis is used, patients tend to be more relaxed, to feel less pain, to be generally more cooperative toward procedures necessary for the healing process and for feelings of well- being. Hypnosis can be used during surgery along with chemoanesthesia or as a sole anesthesia when chemoanesthesia is considered harmful to the patient. Following operation, hypnosis can be used to reduce pain and enhance healing. By directing the patient's attention to optimistically undertaking the activities of moral life, improve morale, aid in planning and enhance recovery.Hypnosis: an adjunct in density: Hypnosis can be used as an anesthesia both as the only anesthesia or in combination with chemical pain relievers. It can be used for cleaning and filling teeth, extractions, pulpectomy, pulpectomy, and periodontal curette. Hypnosis may be used because the patient desires it instead of chemoanalgesia or because the patient's health would be threatened or because of unfavorable reaction to chemoanalgesia. Perhaps one of the most useful uses of hypnosis is in helping the patient deal with the anxiety associated with dental procedures. By relaxation many overt signs of anxiety disappear. Hypnosis can be used to help reduce the impact of past negative dental experiencesThe use of hypnosis in childbirth preparation. (1) Training rehearsals for actual labor. This method helps reduce the anxiety produced by facing ones unknown and potentially frightening experience. They go through a successful pain free delivery in the hypnosis rehearsal. (2) Relaxation is an element in most hypnotic procedures to produce a more favorable outcome. (3) It is possible to substitute a minor symptom for the pain. Pressure or tingling sensations is substituted for the pain of contractions. (4) The symptom may be moved to another part of the body. For example the rhythm of contractions felt in the abdomen can be displaced to rhythmic contraction felt elsewhere in the body such as the hand. Tighten the hand with each contractions helps to complete the displacement of feelings to the hand. (5) Direct suggestion for relief of discomfort may be satisfactory. (6) Indirect suggestion of pain relief. After anesthesia is produced in the hand with suggestions of numbness, the patient practices transfer the numbness from the hand to the abdomen. (7) utilization of imagery such as relieving some pleasant experience from the past. (8) Past hypnotic suggestion can be given at any stage. Suggestion are used to reduce postoperative pain and discomfort, to make the whole experience satisfying which is carried over to the postpartum period. The evidence is clear that for many women hypnotic preparation can provide for a comfortable labor and delivery. The mother is aware of what is going on and can assist in the birth process with a minimum of pain.How to recognize psychosomatic problems: Psychological pain serves some purpose for the individual. A way to work with patients who may have psychosomatic pain which I have found helpful is by questioning the subconscious. After a person in hypnosis, have a "yes" finger to use for a "yes" answer and a "no finger to use for a "no" answer. Some questions used, Is there some emotional reason for your pain? Is your subconscious willing for you to know what is causing your pain? Is there something from the past that is causing the pain? Is there some belief causing your pain? Are you using the pain to punish yourself? Are you using pain to punish someone else? Are you experiencing pain because of some idea that went into your mind during childhood? Are there any fears in your mind causing the pain? Is there some conflict over sex that is causing the pain? Are you experiencing some benefit from the gain? Are you experiencing pain because you feel guilty about something? Is there any reason you need to continue to have the pain? Is it okay for you to get rid of the pain?The use of hypnosis as a controller of pain indicates: (1) The greater the expectation of the patient, the greater the chance to reduce pain through hypnotically suggested analgesia. (2) Hypnosis may have a quieting effect, but does not itself produce analgesia. Analgesia occurs following specific suggestions for pain reduction, which are usually given directly or indirectly. (3) Hypnosis frequently contributes to anxiety reduction. (4) Hypnotic pain reduction procedures are equally applicable to many painful conditions. (5) Teach patient self-hypnosis. In most cases when I use hypnosis, I teach the patient self-hypnosis, With self-hypnosis, the patient is more independent because the patient can use self-hypnosis when I am not available. Hypnosis does not merely produce relaxation and relief from anxiety and thus make the pain more tolerable but is capable of reducing the pain itself so that it is greatly reduced or not felt at all. Hypnosis can also he use for headaches, back pain, phantom limb pain, peripheral nerve injury, arthritis and post traumatic pain.The "Hidden Observer": The person who is successful at reducing pain through hypnosis is merely deploying his attention away from the pain: The use of tile "Hidden Observer" would indicate that the individual is feeling pain at one level but is not consciously aware of the pain. The "hidden observer" is a metaphor for something occurring at an intellectual level but not available to the consciousness of the hypnotized person. it does not mean that there is some sort of secondary personality with a life of its own - a kind of homunculus lurking in the shadow of the conscious person. The "hidden observer" is merely a convenient label for the information source tapped through experiments with automatic writing or automatic talking. An important observation whose covert pain differed from overt pain, was there was no distress connected with it; the hidden pain was sensory pain of high intensity, but unaccompanied by suffering. When suggestions for hypnotic analgesia are successful, the patient feels neither pain nor suffering at the conscious level within hypnosis. When the hypnosis is terminated, he remembers only his comfort in what would otherwise have been a painful situation.